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. 2022 May 19;57(8):1217–1239. doi: 10.1038/s41409-022-01691-w

Table 2.

Proposed classification of transplant indications for adults—2022.

Disease Disease status MSD allo MUD allo MMAD allo Auto CAR-T
Haematological malignancies
AMLa CR1 (favourable risk and MRD–)b GNR/II GNR/II GNR/II CO/I
CR1 (favourable risk and MRD+)b S/II CO/II CO/II GNR/II
CR1 (intermediate risk)b S/II CO/II CO/II CO/I
CR1 (adverse risk)b S/II S/II S/II GNR/I
CR2 S/II S/II S/II CO/II
APL Molecular CR2 S/II CO/II GNR/III S/II
Relapse or refractory CO/II CO/II CO/II GNR/III
ALLa Ph (–), CR1 (standard risk and MRD–)b GNR/II GNR/II GNR/III CO/III
Ph (–), CR1 (standard risk and MRD+)b S/II CO/II CO/II GNR/II CO/II
Ph (–), CR1 (high risk)b S/II S/II CO/II GNR/III
Ph (+), CR1 (MRD–) S/II S/II CO/II CO/III
Ph (+), CR1 (MRD+) S/II S/II S/II GNR/II
CR2 S/II S/II S/II GNR/II
Relapse or refractory CO/II CO/II CO/II GNR/III
CML 1st CP, failing 2nd or 3rd line TKI S/II S/II CO/III GNR/II
Accelerated phase, blast crisis or >1st CP S/II S/II CO/II GNR/III
Myelofibrosis Primary or secondary with an intermediate-2 or high DIPSS score S/II S/II S/III GNR/III
MDS Very low and low-risk (IPSS-R) CO/II CO/II CO/II GNR/III
Intermediate-risk without additional factorsc (IPSS-R) CO/II CO/II CO/II CO/II
Intermediate-risk with additional factorsc (IPSS-R) S/II S/II S/II GNR/III
High-, very high-risk (IPSS-R) S/II S/II S/II
sAML in CR1 or CR2 S/II S/II
CMML CMML-2 or MP-CMML S/II S/II S/II GNR/III
CMML-0 or CMML-1 with additional risk factorsd S/II S/II S/II GNR/III
CLL Poor risk disease refractory or relapsing after at one line of prior therapy (Richter’s transformation excluded) CO/II CO/II GNR/III GNR/III CO/II
Richter transformation S/II S/II S/II GNR/III CO/II
LBCL CR1 (intermediate/high IPI at diagnosis) GNR/III GNR/III GNR/III CO/I GNR/III
Untested relapse GNR GNR GNR GNR S/I
Chemosensitive early relapse, ≥CR2 CO/II CO/II D/III CO/I S/II
Chemosensitive late relapse, ≥CR2 CO/II CO/II D/III S/II CO/II
Chemosensitive relapse after auto-HSCT failure CO/II CO/II CO/III GNR/III S/II
Refractory disease CO/II CO/II CO/III GNR/I S/I
Primary CNS lymphoma GNR/III GNR/III GNR/III S/II D/III
FL CR1, untransformed GNR/III GNR/III GNR/III GNR/II GNR/III
CR1, transformed into high-grade lymphoma GNR/III GNR/III GNR/III CO/III GNR/II
Chemosensitive relapse, ≥CR2 CO/III CO/III GNR/III S/II GNR/III
≥CR2 after auto-HSCT failure S/II S/II D/III GNR/III CO/II
Refractory CO/II CO/II CO/III GNR/III CO/II
MCL CR1 GNR/III GNR/III GNR/III S/I GNR/III
CR/PR >1, no prior auto-HCT CO/III CO/III D/III CO/II S/II
CR/PR >1, after prior auto-HCT CO/II CO/II CO/III GNR/II S/II
Refractory CO/II CO/II CO/III GNR/II S/II
WM CR1 GNR/III GNR/III GNR/III GNR/III GNR/III
Chemosensitive relapse, ≥CR2 GNR/III GNR/III GNR/III CO/II GNR/III
Poor risk disease CO/II CO/II D/III GNR/III GNR/III
PTCL CR1 CO/II CO/II GNR/III CO/II GNR/III
Chemosensitive relapse, ≥CR2 S/II S/II CO/III CO/II GNR/III
Refractory CO/II CO/II CO/III GNR/II GNR/III
Primary CTCL EORTC/ISCL Stages I–IIA (early) GNR/III GNR/III GNR/III GNR/III GNR/III
EORTC/ISCL Stages IIB–IV (advanced) CO/III CO/III D/III GNR/III GNR/III
HL CR1 GNR/III GNR/III GNR/III GNR/I GNR/III
Chemosensitive relapse, no prior auto-HCT D/III D/III GNR/III S/I GNR/III
Chemosensitive relapse, after prior auto-HCT S//II S/II S/II CO/III GNR/III
Refractory D/II D/II D/III CO/III GNR/III
MM Upfront standard risk CO/II CO/II GNR/III S/I
Upfront high risk S/III S/III CO/II S/I
Chemosensitive relapse, prior auto-HCT CO/II CO/II CO/II S/II GNR/III
Refractory/relapse after three lines of prior therapy including an immunomodulatory agent, a proteasome inhibitor and an anti-CD38 S/II
AL CO/III CO/III GNR/III CO/II
Other diseases
Acquired SAA and AA/PNH Newly diagnosed S/II CO/II GNR/III NA
Relapsed/refractory S/II S/II CO/II NA
Haemolytic PNH GNR/II GNR/II GNR/II NA
Constitutional BMF syndromes/SAAe S/II S/II CO/II NA
Breast Ca Adjuvant high risk, selected population NA NA NA D/CO/I
Metastatic, chemosensitive D/II NA NA D/CO/II
Germ cell tumours Second line, high risk GNR/III NA NA CO/II
Primary refractory, second and further relapse GNR/III NA NA S/II
Ovarian Ca High risk/recurrent GNR/II NA NA GNR/I
Medulloblastoma Post-surgery, high risk/recurrent disease NA NA NA CO/III
Small cell lung Ca Limited NA NA NA GNR/I
Soft tissue Sa Advanced D/III NA NA D/II
Ewing’s Sa Locally advanced/metastatic, chemosensitive D/III NA NA CO/II
Renal cell Ca Metastatic, refractory to conventional treatments D/II NA NA NA
Colorectal Ca, pancreatic Ca, other selected solid tumours Metastatic, refractory to conventional treatments D/III NA NA NA
Multiple sclerosis Highly active RR-MS failing DMT D/III GNR/III GNR/III S/I
Progressive MS with AIC, and Aggressive MSf D/III GNR/III GNR/III CO/II
Progressive MS without AIC GNR/III GNR/III GNR/III GNR/III
Systemic sclerosis D/III GNR/III GNR/III S/I
SLE D/III GNR/III GNR/III CO/II
Crohn’s disease D/III D/III D/III CO/II
Rheumatoid arthritis D/III GNR/III GNR/III CO/II
JIA CO/II CO/II CO/III CO/II
Monogenic AD CO/II CO/II CO/III GNR/II
Vasculitis ANCA+ve, BD, Takayasu, others GNR/III GNR/III GNR/III CO/II
PM-DM GNR/III GNR/III GNR/III CO/II
Autoimmune cytopenias CO/II CO/II CO/III CO/II
Neuromyelitis optica D/III D/III D/III CO/II
CIDP, MG and SPS GNR/III GNR/III GNR/III CO/II
Type 1 diabetes GNR/III GNR/III GNR/III D/II
RCD type II GNR/III GNR/III GNR/III CO/II
Primary ID CO/II CO/II CO/II NA

This classification does not cover patients for whom a syngeneic donor is available.

AA aplastic anaemia, AD autoimmune disorders, AIC active inflammatory component, AL amyloidosis, ALL acute lymphoblastic leukaemia, Allo allogeneic transplantation, AML acute myeloid leukaemia, APL acute promyelocytic leukaemia, Auto autologous transplantation, Ca cancer or carcinoma, CAR-T chimeric antigen receptor T cells, CIDP chronic inflammatory demyelinating polyneuropathy, CLL chronic lymphocytic leukaemia, CML chronic myelogenous leukaemia, CMML chronic myelomonocytic leukaemia, CO clinical option (can be carried after careful assessment of risks and benefits), CP chronic phase, CR1, 2, 3 first, second, third complete remission, CTCL cutaneous T-cell lymphoma, D developmental (further trials are needed), DIPSS dynamic international prognostic score system, DMT disease-modifying treatments, FL follicular lymphoma, GNR generally not recommended, HL Hodgkin lymphoma, HCT haematopoietic cell transplantation, ID immunodeficiency, IPI international prognostic index, IPSS-R revised International Scoring System, JIA juvenile idiopathic arthritis, LBCL large B-cell lymphoma, MCL mantle cell lymphoma, MDS myelodysplastic syndromes, MG myasthenia gravis, MM multiple myeloma, MMAD mismatched alternative donors (cord blood, haploidentical and mismatched unrelated donors), MP-CMML myeloproliferative CMML, MRD minimal residual disease, MS multiple sclerosis, MSD matched sibling donor, MUD well-matched unrelated donor (8/8, 10/10, or 9/10 if mismatched is in DQB1), NA not applicable, PM-DM polymyositis-dermatomyositis, PNH paroxysmal nocturnal haemoglobinuria, PR partial remission, RA refractory anaemia, RAEB refractory anaemia with excess blasts, RCD refractory coeliac disease, RCMD refractory cytopenia with multilineage dysplasia, RR-MS relapsing-remitting multiple sclerosis, S standard of care (generally indicated in suitable patients), Sa sarcoma, SAA severe aplastic anaemia, sAML secondary acute myeloid leukaemia, SLE systemic lupus erythematosus, SPS stiff person syndrome, TCL T-cell lymphoma, TKI tyrosine kinase inhibitors, WM Waldenström macroglobulinemia.

aSome centres consider older age (e.g., >60 years) as a criterion for high-risk disease in decision making for allogeneic HSCT for AML or ALL. Beyond transplant indications, maintenance therapy after transplant is being increasingly used with the aim of improving survival outcomes (e.g., FLT3 inhibitors in FLT3-ITD AML [346]).

bCategories are based on number of white blood cells, cytogenetics and molecular markers at diagnosis and time to achieve remission (see text).

cAdditional factors include >5% marrow blasts, poor karyotype, profound cytopenias (i.e., Hb <80 g/L, ANC <0.8 × 109/L, platelets <50 × 109/L), or severe BM fibrosis.

dAdditional high-risk gene mutations (ASXL1, RUNX1, SETBP1, N-RAS), severe cytopenia or transfusion dependency, excessive proliferative features or extramedullary involvement.

eConstitutional SAA includes Fanconi anaemia, dyskeratosis congenita, Blackfan–Diamond anaemia and other inborn bone marrow failure syndromes (see also the section and table for paediatric indications).

fAggressive MS as per Menon et al. [347].